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  • Disaster Mitigation For Health Facilities

    Guidelines for Vulnerability Appraisal and Reduction in The Caribbean

    Pan American Health Organisation Regional Office of the World Health Organisation

    European Community Humanitarian Office

    2000

  • ISBN 976 8078 00 6

    The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Caribbean Programme Coordinator, Pan American Health Organization, P.O. Box 508, Bridgetown, Barbados, W.I., who will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available.

    Cover photograph: Severe damage to a hospital in the Caribbean following a Hurricane (PAHO).

    Many health administrators, engineers and others have contributed to this publication and it is not possible to acknowledge them all individually. However Marcel Clodion, Regional Advisor for the European Community Humanitarian Office (ECHO) and Dana Van Alphen, PAHO Regional Advisor in Disaster Preparedness in the Caribbean provided both financial and other support, and Claudio Osorio, PAHO Advisor in Disaster Mitigation in Costa Rica submitted useful comments on the draft. Tony Gibbs, Director of Consulting Engineers Partnership Ltd., Barbados applied his special expertise as the Technical Advisor and David Taylor, PAHO Advisor in Hospital Management, Office of Caribbean Programme Coordination contributed the narrative and provided overall editorial direction. Finally, special thanks go to Curtis Challenor of Genesis Graphics, Barbados who assembled the document for the printers and patiently incorporated many last minute changes.

    Financial Support for this publication was provided by the European Community Humanitarian Office (ECHO).

  • Table of Contents

    Introduction ...........................................................................................................4

    1. What is Mitigation? ............................................................................................................................5

    2. Role of Health Staff ............................................................................................................................6

    3. Using the Guide ..................................................................................................................................7

    Annexes

    i. Checklist for Vulnerability Surveys (Wind) .................................................................................9

    ii. Illustrations (Wind) .....................................................................................................................15

    iii. Checklist for Vulnerability Surveys (Earthquakes) .....................................................................28

    iv. Illustrations (Earthquakes)...........................................................................................................35

    v. Checklists for Maintenance Operations ......................................................................................49

    Bibliography ............................................................................................................................................56

  • Guidelines for Vulnerability Appraisal and Reduction in The Caribbean

    4

    INTRODUCTION

    This booklet, written primarily for the Caribbean, is based on the “Guide to Making Your Home Hurricane Resistant” published by the United Insurance Company Limited of Barbados, although its scope is wider than hurricanes in recognition of the threat of other natural hazards that exist in the Caribbean. It is fortunate that the technical author of the United Insurance Guide, Mr. Tony Gibbs, made available to PAHO his special expertise in this field and is responsible for the technical aspects of this guide.

    The underlying principle of both the Insurance Guide and this one is that we all have a responsibility to protect our homes and our families and in the case of those who work in the health field our patients, visitors and staff from the dangers of natural hazards. This Guide seeks to help to do that not in the expectation that its use will create a group of technical experts, but rather, by making the technical expertise available in a form that can be used by the non-technical person.

    The checklists reproduced in the Annex were first used in health facilities as part of a Workshop held in the British Virgin Islands in July 1998. The comments and suggestions of those participants have been incorporated in this final version and have undoubtedly contributed to its value.

    The Guide is being published at the end of the decade that was designated by the United Nations as the “International Decade for Natural Disaster Reduction”. This timing therefore recognizes the need to persevere with the initiatives begun in the years up to 1999, in order to continue to ensure the safety of members of the community and the staff themselves in the event of natural hazards.

    To reduce the losses and dangers from spilt chemicals and drugs, shelves and cupboards should be designed with adequate restraints. (Photo PAHO)

    Plaster ceilings should be

    checked for vulnerability to

    falling in earthquakes.

    (Photo PAHO)

    Although the structure was undamaged, the widespread loss of roof sheets in a hurricane meant that the hospital was effectively unuseable. (Photo Tony Gibbs)

  • Disaster Mitigation For Health Facilities

    5

    1. WHAT IS MITIGATION?

    During the last 15 years, it is estimated that over 90 hospitals and over 500 health centres in Latin America and the Caribbean have been damaged by natural hazards. These have been documented in more detail in other publications (see Bibliography) but probably the most serious both in terms of loss of life and injury and impact on the health services was the 1985 earthquake in Mexico City. This event affected three of the largest hospitals in the city, resulting in the loss of 856 lives and 5,829 beds.

    The impact a hazard has on inadequately designed and constructed facilities can lead to disasters.

    A disaster therefore, is an event that occurs usually unexpectedly and suddenly causing severe hardship to people or things, sometimes resulting in the destruction of property, damage to the environment and possibly injury and loss of life.

    Examples of natural hazards are:

    Earthquakes Hurricanes Volcanic eruptions Tsunamis (tidal waves/storm surges) Landslides (some) Torrential rains/loods (some)

    In addition, there are “slow onset” disasters such as droughts and epidemics and also “Man-made” disasters such as fires, explosions, contamination etc. All have relevance and have to be taken into account as we look at our health facilities.

    What has also been demonstrated, particularly in relation to hurricanes, is that relatively low cost retrofitting can protect buildings and equipment, thus allowing facilities to remain functional, and in some cases these measures can save lives.

    Mitigation can be defined as the reduction or prevention of damage that a hazard may cause. It refers specifically to preventive activities pre-event, compared with response in the immediate aftermath, and rehabilitation in the medium to long term. Specifically in relation to health facilities the objectives of mitigation are:

    To protect the public (patients, visitors etc.) and staff from injury or death

    To enable critical departments to remain functional during and immediately after an event.

    A paediatric ward was made roofless during a hurricane because of the inadequate strength of rafters and their connections. (Photo Tony Gibbs)

    The equipment in an intensive-care unit should be secured against toppling and sliding during earth- quakes. (Photo PAHO)

  • Guidelines for Vulnerability Appraisal and Reduction in The Caribbean

    6

    2. ROLE OF HEALTH STAFF

    This Guide has been prepared for health staff who have an important role to play both in relation to their specific responsibilities to provide safe facilities for the public and patients and more generally as advocates of preparedness in their communities and own homes.

    It is not intended that they should become technical experts but rather that they should be able to participate in an informed way in identifying the measures to be taken and in the setting of priorities. It is anticipated that the Guide will be used by the “managers” i.e. the nurses in charge of polyclinics and health centres, hospital administrators and heads of departments.

    The final responsibility for correcting any problems identified through the use of this Guide will probably fall to the Public Works Department or the Maintenance Department and if possible they should be involved in any inspection tours of the facility. However, one of the purposes of this Guide is to reduce dependency on these Departments and enable the health staff to make reasonably informed decisions about the vulnerability of their facilities.

    The Guide does not replace any existing Building Codes that should always be followed during both the construction of new, and the retrofitting of existing buildings.

    The strengthening of unreinforced masonry walls by applying a reinforced-concrete skin during the ret- rofitti